Effect of peridural anesthesia on kidney function]

A complex study of hemodynamics and renal function in 30 patients with adenoma of the prostate during peridural anesthesia has been carried out. The functional renal reaction depends upon the scope of the sympathetic blocade in peridural anesthesia and bears an intimate relation to hemodynamic and neurohumoral effects of the developing blocade. All these changes are of a temporary character and regain values close to the initial ones by the time of the adaptation of the body to peridural anesthesia and stabilization of hemodynamics.     

Peridural anesthesia in operations for toxic goiter

The authors employed peridural anesthesia in 92 patients with thyrotoxicosis According to their findings peridural anesthesia produced favourable shifts in the status of the cardiovascular system and ventilatory apparatus. Peridural anesthesia is considered to be a more acceptible method of anesthesiological provision in patients with toxic goiter than infiltrationanesthesia and intratracheal fluothane anesthesia.     

Choosing the method of anesthesia in aortofemoral shunting

The influence of 4 kinds of anesthesia (neuroleptanalgesia, peridural anesthesia by trimecaine hydrochloride, peridural morphine analgesia, fluoroxene anesthesia) upon the process of reestablishment of blood circulation in lower extremities and possibilities of using a rheographic method for the intraoperative assessment of the efficiency of the aorto-femoral shunting were studied in 112 patients with the help of rheography of the shin and great toes. The authors recognize that trimecaine hydrochloride anesthesia and peridural sympathetic block allow with the help of rheography to timely detect an inadequacy of the aorto-iliac reconstruction in 9 cases.     

Prolonged peridural anesthesia after operations on the chest cavity organs in elderly patients]

From the analysis of 126 observations of the longlasting peridural anesthesia in elderly patients following operations on the lungs and thoracic organs the author notes a high effectiveness of the method. Anatomical peculiarities of the spine structure in elderly individuals make for a more frequent occurrence of such complications as impossibility to perform the puncture of the peridural space, puncture of the dura mater, drop of the arterial pressure etc. The frequency of complications was 23%; in 7.9% of them the medicamental treatment was needed. The use of the longlasting peridural anesthesia favoured an early motor activity of the elderly patients, a rapid normalization of the bronchial motor function and decrease of the rate of postoperative pulmonary complications. The longlasting peridural anesthesia should be widely applied in geriatric surgery.     

Role of prolonged peridural anesthesia in the complex of therapeutic measures after operations on the gastrointestinal tract]

On the grounds of an analysis of 577 observations over postoperative longlasting peridural anesthesia its favorable effect upon the gastrointestinal function and upon the prevention of postoperative pulmonary complications has been shown. The importance of an individual approach to the indications of peridural anesthesia in the postoperative period is emphasized.     

Comparison of anesthetic solutions used in lumbar and caudal peridural anesthesia

Clinical observations on peridural anesthesia were made in 466 patients. The spread of various concentrations of anesthetics injected into the lumbar and caudal peridural space were followed by plotting analgesia-time profiles. Onset of anesthesia and the volume required to provide one dermatome of anesthesia varied little among different anesthetics given in different concentrations. The sequence of appearance of analgesia was also similar, with longer times being required to block larger roots. Quality of anesthesia was judged by the penetration of anesthestic solutions into the largest spinal nerve root (S1); rate of penetration depended on the type of drug and concentration. No drug concentration combination included all the ideal characteristics for block: minimal mass of anesthetic, maximum spread, long duration (minutes of anesthesia per milligram of drugs per segment), low incidence of failure, and fast stabilization time. However, depending on the surgical needs and the characteristics of the patients, some drugs and concentrations may be preferred. Stabilization and onset were slower and drug requirements larger for caudal than for lumbar peridural anesthesia.     

Continuous peridural anesthesia in thoraco-abdominal surgery in children

The authors have generalized the experience of using continuous peridural anesthesia in 204 children of different ages after operations on thoraic and abdomenal organs in acute pneumonias and marked enteroparesis. The efficiency of this method (96,1%) is shown. The authors believe the continous peridural anesthesia to be the method of choice after injuring operations and in stable enteropareses caused by peritonitis, pneumonia.     

Long-term peridural anesthesia in fractures of pelvic bones]

A continuous peridural anesthesia was used in 20 patients with pelvic bones injuries. Puncture of the peridural space was performed in an appropriate patient's posture. During 3--15 days 5--12 ml of 2% trimecain solution were infused via a catheter. For patients being in a shock condition the anesthetic dose was 3-4 ml less. 4-5 minutes following injection of the anesthetic in the peridural space pain at the site of fracture disappeared, there was noted a stabilization of hemodynamic indices, and the ventilatory and cardiac functions were improved. Anesthesia contributes to an early restoration of intestinal peristalsis, diuresis, active management of patients in bed. Strict rules of its conduction being followed, continuous peridural anesthesia is an effective method of analgesia in pelvic bones injuries, associated with a traumatic shock, that enabled to use it in traumatological practice.     

Myocardial contractility during peridural anesthesia.

Cardiac contractility was studied in 4 groups of patients using, as parameter, the I/(PEP)2 index proposed by Reitan. 15 patients received 10 mg diazepam i.v. as sedation. The patients in group I were given lumbar peridural anesthesia with 20 ml prilocaine 2%. There was no significant change in the index. The patients in group II were given lumbar peridural anesthesia with 20 ml prilocaine and adrenalin 1/200,000. For 20 to 30 minutes there was a marked rise in the index. The patients in group III received the same lumbar peridural anesthesia as group II, but with a subsequent subcutaneous injection of 50 mg ephedrine HCl. At first the index rose rapidly; this rise was followed by a more rapid return to the initial value. Finally, the patients in group IV, who were under stabilized NLA narcosis, received 2 mg/kg prilocaine intravenously. There was no change in the index before and after the injection.     

Anesthesiologic aspects of extracorporeal shockwave lithotripsy (ESWL)

Anesthesiological considerations are discussed on the basis of the limited literature available and our own experience with more than 2000 ESWL treatments. Guidelines concerning anesthesia technique and ESWL treatment of renal and ureteral stones are outlined and compared to our own results and those in the literature. The following techniques are discussed: intubation anesthesia with halogenated carbohydrogens (Fluothane, Ethrane), intubation anesthesia with Fluothane/Ethrane plus opiates, neuroleptic anesthesia, catheter peridural anesthesia (lumbar/thoracic), opiate analgesia and high frequency jet ventilation.     

基层医院开展腹腔镜微创手术无严重并发症的体会

目的 :总结在基层医院开展腹腔镜微创手术的经验。方法 :在连续硬膜外麻醉下行腹腔镜微创手术 118例 ,其中阑尾切除术 7例 ,卵巢囊肿摘除术 5例 ,宫外孕手术 1例 ,胆囊切除术 10 0例 ,胆囊切除加胆总管取石术 5例。有腹部手术史 39例。结果 :无中转开腹手术与输血病例 ,均痊愈出院 ,平均住院 5 6d。结论 :连续硬膜外麻醉下行腹腔镜手术具有方便易行 ,安全 ,患者损伤小 ,痛苦小 ,效果好 ,并发症少 ,术后康复快等优点 ,适合广大基层医院开展     

Subarachnoid anesthesia and peridural anesthesia: which are the causes of total failure? A clinical case]

The paper reports the case of patient undergoing cystoscopy and subsequently radical cystectomy suffering from BPCO and pulmonary emphysema who received sub-arachnoid anesthesia during the first operation and peridural anesthesia during the second, with total failure both times. The techniques were correctly performed and on both occasions it was necessary to resort to general anesthesia in order to perform the operation.     

Changes of certain indicators of gas exchange and hemodynamics under conditions of long-term peridural anesthesia after lung resection]

A continuous peridural anesthesia after pulmonary resection was conducted in 200 patients aged from 3 to 72 years. The anesthesia would contribute to a prompt normalization of ventilatory indices and acid-base balance in early terms, it also improves hemodynamics. This method of postoperative anesthesia enabled the authors to reduce the number of tracheobronchial obturations in the surgical department from 8.4% to 5.1%.     

Perioperative protection of the gastrointestinal tract

The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke a variety of consequences for the entire organism and influence the inflammatory response in particular. In perioperative medicine, nutrition, prokinetics, peridural anesthesia, catecholamines and volume therapy can be applied in order to improve the gastrointestinal functional or at least to avoid further aggravation. Early enteral nutrition is especially important in the reduction of postsurgical ileus and infectious complications. Also, prokinetics and thoracic peridural anesthesia favorably affect postsurgical ileus. Norepinephrine, if necessary in combination with dobutamine, seems to have fewer negative effects on splanchnic perfusion than epinephrine. The data on volume therapy remain controversial but fluid balance has to be calculated very carefully also considering enteral loss of fluids. Thus, in order to treat and avoid gastrointestinal problems after surgery and to prevent negative effects for the complete organism, multimodal concepts with regard to detail are required.     

Prolonged peridural anesthesia with pyromecaine

On the basis of using the home anesthetic drug promekain for prolonged peridural anesthesia in the postoperative period in 110 patients its longer analgetic effect is shown with the minimum influence upon the cardio-vascular system.     

腹腔镜精索内静脉结扎术11例报告

应用腹腔镜技术为11例患者行精索曲张静脉高位结扎术。硬膜外麻醉,手术均获成功,无一例发生并发症,手术时间20～70min,术后当天下床活动,次日出院。对该手术方法的优缺点和适应证进行了讨论。     

Peridural anesthesia with morphine and trimecaine: an analysis of 2000 cases

Complex investigations of 2000 patients have shown that peridural anesthesia represents an adequate anesthesiologic defense of the patient from the operative stress. The potentiating effect of morphine is greater with greater doses and results in systemic elevation of sensory thresholds, suppression of the emotional component of perception of pain and a prolongation of anesthesia. A conclusion is made that in some patients operations on lower extremities and small pelvis organs should be performed under peridural anesthesia in combination with subnarcotic doses of sedative drugs.     

Prolonged peridural anesthesia in the treatment of acute pancreatitis

An analysis of results of continuous peridural anesthesia in 65 patients with inflammatory and traumatic injuries of the pancreas has shown the effectiveness of an analgetic effect and favourable influence of blockade on motor activity of the intestine. The author describes complications, indications and contraindications.     

Hemodynamic Drug Interaction: Peridural Lidocaine and Intravenous Ephedrine

Hypotension following peridural anesthesia with lidocaine was treated by intravenous injection of ephedrine. The ephedrine relieved the cardiovascular depression, but was associated with a concomitant increase in plasma lidocaine concentrations. This increase may push the plasma lidocaine concentration into the toxic region.     

Early reversal of postoperative hypoxemia.

Peridural analgesia was combined with the respiratory-stimulant effect of doxapram for intermittent hyperinflation of the lungs to reverse early postoperative (PO) hypoxemia following inhalation anesthesia for upper abdominal operations. Twenty unpremedicated men undergoing upper abdominal operations were studied for 5 hours in the recovery room. Ten of these patients received doxapram plus peridural analgesia; the other 10, doxapram plus morphine analgesia. Rectal temperature, PaO2, PaCO2, respiratory rate, exhaled minute ventilation (VE), tidal volume (VT), and blood pressure and pulse were measured. The mean increase from control for VE was 9.6 L/min and for VT, 356 ml/breath during doxapram therapy for the morphine group. Corresponding values for the peridural group were 14.4 L/min for VE and 660 ml/breath for VT. Mean PaO2 for the morphine group decreased significantly from the corresponding preoperative value (p less than 0.005). Lack of significant change between preoperative and PO values for PaO2 for the peridural group would indicate that under the conditions of this study, early PO hypoxemia can be reversed by the combination of peridural analgesia with doxapram therapy.